Department of Population, Family and Reproductive Health
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Item TRIPS, the Doha Declaration and increasing access to medicines: policy options for Ghana(Globalization and Health, 2005) Cohen, J.C.; Gyansa-Lutterodt, M.; Torpey, K.; et al.There are acute disparities in pharmaceutical access between developing and industrialized countries. Developing countries make up approximately 80% of the world's population but only represent approximately 20% of global pharmaceutical consumption. Among the many barriers to drug access are the potential consequences of the Trade Related Aspects of Intellectual Property Rights (TRIPS) Agreement. Many developing countries have recently modified their patent laws to conform to the TRIPS standards, given the 2005 deadline for developing countries. Safeguards to protect public health have been incorporated into the TRIPS Agreement; however, in practice governments may be reluctant to exercise such rights given concern about the international trade and political ramifications. The Doha Declaration and the recent Decision on the Implementation of Paragraph 6 of the Doha Declaration on the TRIPS Agreement and Public Health may provide more freedom for developing countries in using these safeguards. This paper focuses on Ghana, a developing country that recently changed its patent laws to conform to TRIPS standards. We examine Ghana's patent law changes in the context of the Doha Declaration and assess their meaning for access to drugs of its population. We discuss new and existing barriers, as well as possible solutions, to provide policy-makers with lessons learned from the Ghanaian experience.Item Task-shifting HIV counselling and testing services in Zambia: the role of lay counsellor(Human Resources for Health, 2009) Sanjana, P.; Torpey, K.; Schwarzwalder, A.; et al.Background: The human resource shortage in Zambia is placing a heavy burden on the few health care workers available at health facilities. The Zambia Prevention, Care and Treatment Partnership began training and placing community volunteers as lay counsellors in order to complement the efforts of the health care workers in providing HIV counselling and testing services. These volunteers are trained using the standard national counselling and testing curriculum. This study was conducted to review the effectiveness of lay counsellors in addressing staff shortages and the provision of HIV counselling and testing services. Methods: Quantitative and qualitative data were collected by means of semistructured interviews from all active lay counsellors in each of the facilities and a facility manager or counselling supervisor overseeing counseling and testing services and clients. At each of the 10 selected facilities, all counselling and testing record books for the month of May 2007 were examined and any recordkeeping errors were tallied by cadre. Qualitative data were collected through focus group discussions with health care workers at each facility. Results: Lay counsellors provide counselling and testing services of quality and relieve the workload of overstretched health care workers. Facility managers recognize and appreciate the services provided by lay counsellors. Lay counsellors provide up to 70% of counselling and testing services at health facilities. The data review revealed lower error rates for lay counsellors, compared to health care workers, in completing the counselling and testing registers. Conclusion: Community volunteers, with approved training and ongoing supervision, can play a major role at health facilities to provide counselling and testing services of quality, and relieve the burden on already overstretched health care workers.Item Prevention of mother-to-child transmission of HIV in Zambia: implementing efficacious ARV regimens in primary health center(BMC Public Health, 2009) Mandala, J.; Torpey, K.; Kasonde, P.; et al.Background: Safety and effectiveness of efficacious antiretroviral (ARV) regimens beyond single-dose nevirapine (sdNVP) for prevention of mother-to-child transmission (PMTCT) have been demonstrated in well-controlled clinical studies or in secondary- and tertiary-level facilities in developing countries. This paper reports on implementation of and factors associated with efficacious ARV regimens among HIV-positive pregnant women attending antenatal clinics in primary health centers (PHCs) in Zambia. Methods: Blood sample taken for CD4 cell count, availability of CD4 count results, type of ARV prophylaxis for mothers, and additional PMTCT service data were collected for HIV-positive pregnant women and newborns who attended 60 PHCs between April 2007 and March 2008. Results: Of 14,815 HIV-positive pregnant women registered in the 60 PHCs, 2,528 (17.1%) had their CD4 cells counted; of those, 1,680 (66.5%) had CD4 count results available at PHCs; of those, 796 (47.4%) had CD4 count d 350 cells/mm3 and thus were eligible for combination antiretroviral treatment (cART); and of those, 581 (73.0%) were initiated on cART. The proportion of HIV-positive pregnant women whose blood sample was collected for CD4 cell count was positively associated with (1) blood-draw for CD4 count occurring on the same day as determination of HIV-positive status; (2) CD4 results sent back to the health facilities within seven days; (3) facilities without providers trained to offer ART; and (4) urban location of PHC. Initiation of cART among HIV positive pregnant women was associated with the PHC's capacity to provide care and antiretroviral treatment services. Overall, of the 14,815 HIV-positive pregnant women registered, 10,015 were initiated on any type of ARV regimen: 581 on cART, 3,041 on short course double ARV regimen, and 6,393 on sdNVP. Conclusion: Efficacious ARV regimens beyond sdNVP can be implemented in resource-constrained PHCs. The majority (73.0%) of women identified eligible for ART were initiated on cART; however, a minority (11.3%) of HIV-positive pregnant women were assessed for CD4 count and had their test results available. Factors associated with implementation of more efficacious ARV regimens include timing of blood-draw for CD4 count and capacity to initiate cART onsite where PMTCT services were being offered.Item A review of traditional Ghanaian and Western philosophies of adult education(International Journal of Lifelong Education, 2003-01) Fordjor, P.; Kotoh, A.; Kumah Kpeli, K.; Kwamefio, A.; Bernard Mensa, Q.; Owusu, E.; Mullins, B.The primary objective of this article is to critically examine some aspects of the traditional Ghanaian and Western philosophies of adult education. It is a well-attested fact that many of the pre-colonial and early colonial writers about Africa portrayed Africa as a dark continent devoid of advanced centres of learning worthy of emulation by others. The old West African civilizations of Ghana, Mali and Songhai with advanced centres of learning at Timbuktu and Djenne in the 11th century seemed to have been completely ignored by these writers (Boahen 1967: 20, Davidson 1966b: 50). Even though many other writers including several missionaries, anthropologists and historians, depicted Africa in a rather positive and scientific manner (Davidson 1966b, Goody 1966), much of the negative image created long ago still exists and needs to be examined and corrected. The formal Western system of school education was introduced in Ghana more than a century ago. Despite this, about 60% of the adult population today makes its living as illiterate farmers, workers, apprentices or master craftsmen in the various traditional art and craft production centres. Consequently, traditional adult education continues to play an important role in the social and economic development of the country. Like the Western system of adult education the Ghanaian traditional education has sound philosophical foundations, which have helped to maintain political stability and social cohesion in the country over the years. Much is written about Western and eastern philosophies but there is a dearth of literature on philosophies of adult education from Africa. Given that Africa is the second largest continent on the globe and that adult education proliferates throughout the continent, the authors felt their investigation would make a significant contribution to a global understanding of the field. Additionally, there is an increasing need for African students to appreciate and re-establish confidence in their own culture. This review cannot cover all of Africa so the focus is on Ghana, one country in West Africa. © 2003 Taylor & Francis Group, LLC.Item The impact of the Navrongo Project on contraceptive knowledge and use, reproductive preferences, and fertility(Studies in Family Planning, 2002-06) Debpuur, C.; Phillips, J.F.; Jackson, E.F.; Nazzar, A.; Ngom, P.; Binka, F.N.The Navrongo Community Health and Family Planning Project is a quasi-experimental study designed to test the hypothesis that introducing health and family planning services in a traditional African societal setting will introduce reproductive change. This article presents the impact of the initial three years of project exposure on contraceptive knowledge, awareness of supply sources, reproductive preferences, contraceptive use, and fertility. Findings show that knowledge of methods and supply sources increased as a result of exposure to project activities and that deployment of nurses to communities was associated with the emergence of preferences to limit childbearing. Fertility impact is evident in all treatment cells, most prominently in areas where nurse-outreach activities are combined with strategies for involving traditional leaders and male volunteers in promoting the program. In this combined cell, the initial three years of project exposure reduced the total fertility rate by one birth, comprising a 15 percent fertility decline relative to fertility levels in comparison communities.Item Beyond symptom recognition: Care-seeking for ill newborns in rural Ghana(2008-01) Bazzano, A.N.; Kirkwood, B.R.; Tawiah-Agyemang, C.; Owusu-Agyei, S.; Adongo, P.B.Objectives: To assess newborn care-seeking practices in a rural area of Ghana where most births take place at home in order to inform potential strategies for reducing newborn mortality. Methods: Qualitative, ethnographic study with quantitative data from a birth cohort collected as part of the surveillance system of an ongoing randomized controlled trial. Data collected comprised 84 h of participant observation (including following an ill newborn through a hospital visit), 14 in-depth interviews with key informants (older mothers and grandmothers), 45 semistructured interviews with mothers, 28 case histories from women who had recently given birth and 32 expert interviews with local health providers. Thirteen focus groups were held with men and women, and narrative histories of newborn deaths were taken from eight women. Birth cohort data came from 2878 singletons born alive in the study district within the year July 2003-June 2004. Results: Significant delays in care seeking for ill newborns occur in Kintampo District, Ghana. 2.1% of 2878 newborns in the birth cohort had a serious illness during the first 4 weeks of life, but care was only sought outside the home for 61% of those and from a doctor or hospital for 39%. Barriers to prompt allopathic care seeking include sequential care-seeking practices, with often exclusive use of traditional medicine as first-line treatment for 7 days, previous negative experiences with health service facilities, financial constraints and remoteness from health facilities. Conclusions: Improvements in care seeking are urgently needed. Families should be urged to seek medical care for any symptom of illness in a newborn; financial and socio-cultural barriers to care seeking for newborns must be addressed in order to improve neonatal survival. © 2008 Blackwell Publishing Ltd.Item Trend and causes of neonatal mortality in the kassena-nankana district of northern Ghana, 1995-2002(2006-04) Baiden, F.; Hodgson, A.; Adjuik, M.; Adongo, P.; Ayaga, B.; Binka, F.OBJECTIVES: To describe the trend and causes of neonatal deaths in a rural district in northern Ghana. METHODS: Descriptive analysis of data collected from the Navrongo Demographic Surveillance System and verbal autopsies conducted on all neonatal deaths from 1995-2002. RESULTS: Of 1118 recorded neonatal deaths 1068 (95.5%) could be analysed. Only 13.2% of deaths occurred at the health facility; 62.7% occurred in the early neonatal period, with prematurity (38%) and birth injuries (19%) as leading causes. Infectious causes (66%) were the major contributors to late neonatal deaths. Infanticide accounted for 4.9% of all neonatal deaths. The cause-specific mortality rate for neonatal tetanus remained under 2.5% throughout the 8-year period. Overall, the neonatal mortality rate declined at an average of 2.5 per 1000 live births per year: Down by nearly 50% from 40.9 (95%C.I. 34.1-46.8) in 1995 to 20.5 (95%C.I.17.3-22.7) in 2002. CONCLUSION: The various health interventions undertaken in this district have had the collateral effect of causing decline in neonatal mortality. Neonatal mortality could be further reduced by preventing and treating neonatal infections, having skilled attendance at delivery and the elimination of infanticide. Data from demographic surveillance sites may be useful in monitoring trends in child mortality. © 2006 Blackwell Publishing Ltd.Item Clinic-based surveillance of adverse pregnancy outcomes to identify induced abortions in Accra, Ghana.(Studies in Family Planning, 2008-06) Oliveras, E.; Ahiadeke, C.; Adanu, R.M.; Hill, A.G.Reliable measures of induced abortion remain elusive, especially when the public perception is that the procedure is immoral or improper. This study draws on interviews using a modified preceding birth technique (PBT) with women attending antenatal and maternity clinics in Accra to compare rates of adverse pregnancy outcomes (stillbirths, miscarriages, and induced abortions) with rates from a household maternity history and the Ghana Demographic and Health Survey. The reports from the antenatal clinics produced some of the highest rates for adverse outcomes of pregnancy. In light of the generally high coverage of antenatal services found even in developing countries, the method based on the PBT holds promise for the improvement of reports of miscarriage and abortion worldwide. © 2008 The Population Council, Inc.Item Optimism/pessimism and health-related quality of life during pregnancy across three continents: A matched cohort study in china, Ghana, and the united states.(BMC Pregnancy and Childbirth, 2009) Moyer, C.A.; Yang, H.; Kwawukume, Y.; Gupta, A.; Zhu, Y.; Koranteng, I.; Yasmin, E.; YuMei, W.; Jonathan, G.; Calhoun, C.; Ekpo, G.; Megan, B.; Megan, R.; Adanu, R.; Anderson, F.Background Little is known about how optimism/pessimism and health-related quality of life compare across cultures. Methods Three samples of pregnant women in their final trimester were recruited from China, Ghana, and the United States (U.S.). Participants completed a survey that included the Life Orientation Test - Revised (LOT-R, an optimism/pessimism measure), the Short Form 12 (SF-12, a quality of life measure), and questions addressing health and demographic factors. A three-country set was created for analysis by matching women on age, gestational age at enrollment, and number of previous pregnancies. Anovas with post-hoc pairwise comparisons were used to compare results across the cohorts. Multivariate regression analysis was used to create a model to identify those variables most strongly associated with optimism/pessimism. Results LOT-R scores varied significantly across cultures in these samples, with Ghanaian pregnant women being the most optimistic and least pessimistic and Chinese pregnant women being the least optimistic overall and the least pessimistic in subscale analysis. Four key variables predicted approximately 20% of the variance in overall optimism scores: country of origin (p = .006), working for money (p = .05); level of education (p = .002), and ever being treated for emotional issues with medication (p < .001). Quality of life scores also varied by country in these samples, with the most pronounced difference occurring in the vitality measure. U.S. pregnant women reported far lower vitality scores than both Chinese and Ghanaian pregnant women in our sample. Conclusion This research raises important questions regarding what it is about country of origin that so strongly influences optimism/pessimism among pregnant women. Further research is warranted exploring underlying conceptualization of optimism/pessimism and health related quality of life across countries.Item Contemporary issues in women's health.(International Journal of Gynecology and Obstetrics, 2006-01) Johnson, T.R.B.; Adanu, R.M.K.No abstract
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